I started the morning like gangbusters! I felt good, the coffee tasted right, and I was looking forward to starting my walks back again. After reading newspapers online, I got this strange gurgling sound coming from my belly and I knew that meant there wasn’t going to be a morning walk except to the bathroom and back. After 4 trips, I finally made it back to bed and found out I was in pain no matter what position I placed myself.
What was really strange is that when I took a breath, my left side hurt from the front of my chest to the back of my torso. Being the hypochondriac I am, I immediately figured I was developing pneumonia since Klebsiella pneumoniae is known to cause bacterial pneumonia. I put a call into the Nurse Navigator and left a voice mail about my problems and wanted to know options. I knew if it got worse I would take myself to the emergency room but I also knew that Dr. Burgers said she could work me in tomorrow if needed.
The Nurse Navigator called me back and said I could remove the compression bandage that was wrapped around my chest. That immediately alleviated a lot of the pain I was experiencing. When I finally unwrapped my mummified body, I had a huge wad of gauze sticking out of one of the incisions made on Monday. It had to be most of a whole roll. There was no sense in letting it dangle so I found some scissors and cut off the excess. Hopefully Dr. Burgers will unpack it tomorrow.
The drain is working overtime. This morning I had 50 ml of pinkish blood. Thank goodness it has turned pink and is not blood red any more. That’s what the first drain was supposed to do but did not ever accomplish.
Monday, the day the drain went in, I got 60 ml of red. Tuesday, it was emptied three times and it was 100 ml, the first 30 red and the next 70 was pink.
This morning is was 50 ml and still pink. I still will probably empty the drain one or two more times before the day is over.
Holley and I just figured I’ve had four doses of antibiotic. That leaves 10 doses (5 days) more on that.
Of course, after setting the appointment for tomorrow with Dr. Burgers, I immediately forgot the time. I had to email the Nurse Navigator to find out it was 11:45 so I need to be there around 11:30 am.
It seems every step forward I take, I step two backwards. Better end this now. I hear gurgling again.
Apologies for the lack of a post yesterday but I was a little under the anesthesia. As a matter of fact, I’m still feeling the influence so this blog may (1) not make any sense (2) have a lot of misspellings (3) not get the syntax correct.
Holley was spot on time of arrival at my house and then I proceeded to get her to exit the wrong place. Regardless, we made it to Holy Cross Healthplex before my noon required presence. As you might guess, there were forms to check the accuracy even though I had done that the previous day online. By 12:30 pm I was taken back for surgical prep. After putting on my gown, booties, and hair net, they allowed Holley to come back and keep me company. We had a good time talking and giggling until we realized it was 1:30. A receptionist appeared in my cubicle and asked if we were expecting anyone else. We both said Tom at the same time.
With the three of us, we probably came very close to being asked to leave. We could take our comedy routine on the road and make a mint. Tom is the person I helped through his stay at Broward Health a few months ago. I think he finally left around 5:30 (everything is still hazy) and soon after the anesthesiologist showed up and I was wheeled back to the operating room. It certainly was pristine and well managed. I shifted to the operating table, they place my arms at right angles to my body and covered my arms to keep them from getting cold. Then the anesthesiologist said you are going to get very sleepy and that’s the last thing I remembered until waking up in recovery. Later, I think they had to put me deeper under anesthesia and they must have intubated me for some reason.
What was supposed to be a quick 30 minute procedure took 1 1/2 hours on the operating table. What I write next is second hand from Holley but apparently Dr. Burgers had to make a larger incision than she thought – to the point that the incision was larger than the one for breast removal. Dr. Burgers apparently ran into some unexpected complications. I’ll know more when I get my report from her posted on the Holy Cross app.
In recovery I got chills and they kept running back and forth to provide me with warm blankets, even to the point of putting them back on my arms, around my head, and, of course, my torso and legs and toes. They then hooked up a heater hose to blow warm air on my torso. I was extremely emotional and when the nurse said I must have someone at my house with me after discharge, I broke into tears because I knew Holley couldn’t do it because she had to take her husband to surgery today and she had just spent 7 1/2 hours with me in the Healthplex. If I had known the surgery turned out more serious than anticipated, I could have lined up some help with staying overnight. Of course, Holley said she would stay and I said NO! She had already gone above and beyond.
Dr. Burgers, after the surgery, found Holley in the reception area and went over everything in detail with her. Again, Dr. Burgers goes the extra mile for me and my friends. I now have a drain again. The good news this morning is that it isn’t blood red any more but more pinkish. In addition the swelling has gone down considerably and I’m not in any pain.
After Holley gets me home around 7:30, I start thinking who I can call. Chris lives the closest so I started with her but my call went to voice mail. Next I called Barbara and she immediately volunteered. I felt badly asking with so little lead time but Barb dropped everything, packed a bag, and came over.
As you might also guess, there were prescriptions to be picked up and Jim, Holley’s husband picked them up for me at CVS. I only know this because the medicines appeared and I was told Jim brought them. He even came back to see me in the bedroom but I have no recollection.
Holley spent 7 1/2 hours in the Healthplex and when Barb showed up at the door stayed and went through all the procedures, medications, etc. Holley didn’t leave my house until 11:30 pm. I think she and Barb hit it off and I suspect Jim and I were much the topic for most of the night. I wouldn’t know, I was out of it.
Holley and Barb gave me a Tramadol for pain. Holley convinced Dr. Burgers that even though I had Tramadol at the house, she wouldn’t know where to look for it so got Dr. Burgers to write me a prescription for it. I never took it for the mastectomy but I did for this procedure. Honestly, the mastectomy was a breeze compare to yesterday’s procedure. I was an emotional wreck, weak and trembly, and not to stable when upright.
Somewhere during the last two procedures (Dr. Burger’s office and Healthplex) they determined my bacterial infection to be Klebsiella pneumoniae var.pneumoniae. This is a facultative anaerobic, Gram negative bacterium usually found in the intestines. It’s most often spread through person-to-person contact, particularly when someone infected with it doesn’t wash their hands. The bacterium may cause pneumonia, bloodstream infections, meningitis, and urinary tract infections. It is also considered a nosocomial bacterium which means it was transmitted to me either from my last hospital stay from the first chemo infusion at at Dr. Burger’s examination room. My money is on the first hospital stay or the next one for the mastectomy. I think it also explains why I was not getting any better nor feeling well at all.
The antibiotic Dr. Burgers prescribed is sulfamethoxazole-tmp (also known as Bactrim). It’s like the last antibiotic which I will now discontinue, twice a day, evenly spaced. Dr. Burgers explained Bactrim was a better antibiotic than Cephalexin for Klebsiella.
Before I left the Healthplex yesterday, Dr. Burgers had already scheduled me an appointment on Friday at 10:15 am. Again, this information is all through Holley. If I get worse, go to the emergency room or she could see me on Thursday. I was seriously threatened with bodily harm if (1) I took a shower or (2) changed the bandage or (3) removed the compression wrap around my torso. You do not want to piss off Dr. Burgers, Holley, or Barbara – not if you want to live to tell about it.
I’m a little trembly this morning. I made coffee for Barb and me and I ate my usual fruit and yogurt breakfast. Barb kept washing dishes (Hello! Dishwasher!) and helped organize the kitchen table to look more like a kitchen table than a medical clinic. I have been promised dire consequences if I need her and don’t call her. I feel 100% better than before the surgery. I’m not as swollen and I actually feel good for the first time since my emergency room/hospital stay after the first chemo. I’m still weak and unsteady on my feet. I’ve been told by Drs. H & B to keep my ass in bed.
I don’t know how I deserve good friends. Saints and Sinner and I’m the Sinner. Everyone else has been a Saint!
It was an interesting night. At least the Xanax let me get a good night’s sleep. Unfortunately, it gives me a slight hangover.
The interesting part of last night was when I was getting ready to turn out the light and go to sleep and realized my bandage from the morning session with Dr. Burgers was wet and soaked through. I knew I needed to change it or I would wake up to soaked sheets.
Off came the bloody tee shirt and then I pulled away the bandage. My poor skin has had more tape on it in the last few weeks than ever before and is getting a little sensitive. I’ve always subscribed to the theory to remove it quickly and get the smarting over with. Even that theory is wearing thin. It hurts like hell to take the tape off.
What I had forgotten about was Dr. Burgers said she had packed some sterile gauze into the wound over the breast and as I removed the outer bandage I saw a long piece of gauze dangling from the opening of the incision. I didn’t think. I just decided to pull it out. Big mistake. First it was a lot of packing in the wound and as I pulled, the gauze kept coming.
It reminded me when I used to have nose bleeds as a kid and Dr. Clark packed my nose one time. I pulled that out and wondered how he got that much gauze up my nasal cavity. He had put a whole roll of gauze up my nose. This was kinda the same experience.
The minute I pulled the last of the gauze out, blood gushed all over the place. It was on me, my pajamas, the sink, the bathroom mat, my feet, and it kept coming. You forget how sticky blood is until it gets between your toes. I finally got a piece of gauze up against the incision and applied pressure. The incision was a lot larger than I anticipated. I never get to see what Dr. Burgers is doing when she’s doing it so I had no idea. You can’t really tell what she’s doing since you are numb from the lidocaine.
It kept bleeding and bleeding. Finally, I slowed it down enough to put another piece of gauze and tape over the incision and then I used the ace bandage to wrap around my chest to apply more pressure. I put another tee shirt on top of that and placed a towel on the bed.
Next was pouring hydrogen peroxide over my tee shirt and the bath mat. I really splattered blood all over the mat. After the treatment, I finally got back into bed and slept until 8:30 am.
Today I again need to change the bandage (more bloody tee shirts) and wash all the hydrogen peroxided clothes and bath mat. That’s in addition to regular laundry, cleaning house, and since I didn’t clean the pool filter yesterday, try to get that done. I’ll probably get some washing done but I figure everything else can wait.
The wound area is certainly sore but the real problem is the tightness of the skin in that area. The good news is the swelling over the left breast is down somewhat but I still have the knot of the hematoma under the arm pit.
I think when this is over I’ll write about what they don’t tell you about breast cancer surgery and treatment. They throw so much information at you that you are overwhelmed and forget to tell you little things like the hair of your nose disappears. As a bald person, I tend to grow more hair on my ears than on my head but since the first chemo treatment, I haven’t had to worry about that little issue. There are lots of other little things that you begin to notice that are not in the info sheets they give you.
I think my biggest problem (after bleeding) is diet. I’m pretty much on a junk food diet these days. I’m usually just OK with ice cream. I’m not really a big eater of it but I’ll have two scoops every so often. A gallon (they are not really gallon containers these days) will last months at my place. I’m now up to four scoops a night. I crave Tootsie Rolls. As far as real food goes, I can force it down but I almost never complete a meal.
I know why Tootsie Rolls. My cousin Jimmie’s parents owned a fruit stand they leased out a half a block away when we were kids. Jimmie and I lived on Cokes, potato chips, and, for me, Tootsie Rolls and Milk Duds. When we started going across the street to the fruit stand (we had to cross the very busy Highway 80) the original Coke machine was the type you had to put your money in and move the coke through a sliding track to get it to come out.
Photo from eBay. This is a Pepsi machine but the Coke machines were similar. By the way, you can purchase this on eBay for $3500.
Back then Cokes were 5 cents, potato chips were 5 cents and Tootsie Rolls were 5 cents. We were, of course, outraged when Cokes went to 6 cents.
I haven’t walked in almost a week. I either sleep too late because of the Xanax or I have doctors’ appointments and haven’t time. Of course, I can always use the excuse of it being too hot. I could walk late in the afternoons but then I would be dodging lightning bolts. Let’s face it, it’s hard to keep a routine when going through cancer protocols and I am, if nothing, a creature of habit. That’s the biggest problem for me.
With the Xanax hangover, washing clothes, and no appetite, I think I’ll take it easy this afternoon and wait for the thunderstorms and rain downpours. There’s always a book on my iPad to read.
It’s been a day, starting with a restless night’s sleep. I probably should have taken a Xanax. I will tonight. It seems the pressure builds up in the swelling over what was my left breast and under the arm pit and I kept tossing and turning. Also, every time I got up last night to go to the bathroom it felt like my vertigo was trying to make a come back.
I was early to Dr. Burger’s appointment but didn’t mind waiting. I kept hearing the receptionist handle phone calls. That woman has the patience of Job. No matter how upset the caller, she never raised her voice, always tried to soothe the person on the phone and she handled it with such professionalism. I get the feeling that all their staff undergo empathy training but I think it comes naturally to most of them.
Lorraine, the nurse, took me back for a vitals check and it wasn’t but a minute or two before Dr. Burgers walked in. She first did an ultrasound of the area and offered me two options. She could give me a local in the examining room and try to free up the congealed blood and express it through a small incision or see me in surgery on Monday where she would have more equipment at her disposal.
After thinking it over, she said, let’s try it today. My skin was so tight with the swelling I didn’t even feel the injection of the lidocaine. I did feel the scalpel’s incision but it was so quick it didn’t matter. Then for the next 30-40 minutes she worked on getting the blood out. It was a little like popping a pimple. She pushed and shoved and tried to work what congealed blood she could through the incision.
The knot under my arm pit did not cooperate and did not seem to be connected to the other swelling so she shot that area with lidocaine and did another incision right at that location. Again, pop the pimple time.
She was successful somewhat. Lorraine, who assisted, said she got a lot of semi-solid blood out. Dr. Burgers, at one point, was using forceps to pull some of the stuff out. She really dug in and around those two incisions. Of course, all during this time I was dripping all over the examination table.
She took a swab to send off to the lab to make sure there are no surprises. Unless it comes back positive for bacteria, she doesn’t plan to put me on antibiotics because of my diarrhea issue.
In the end, she decided to go ahead with surgery on Monday. She thinks she can suction all the material out in one go and instead of waiting on my body to absorb the blood over three or four months, cut down the time to a week or two.
She’ll give me a light dose of anesthesia – somewhat like for a colonoscopy. That way I won’t feel anything but won’t be in deep sleep.
I’m now scheduled to go in on August 7th at 12:30 pm at the Holy Cross Healthplex. That’s where they did my bicep surgery. I like the place and they treat you well there. Dr. Burgers said she would try not to put another drain in me but that was a possibility.
She and Lorraine bandaged me up, supplied me with changes in dressings and sent me home. Lorraine told me to use hydrogen peroxide on the blood stains on my shirt. I wore a red shirt just in case. The lidocaine was wearing off (they use a short acting one) and I was in a good bit of pain by the time I got home. I slept for about two hours. I did try the hydrogen peroxide and it took the blood stain out without any scrubbing.
I now have three holes on my left side, all seeping fluids, mostly blood. I’m back to bath wipes since I can’t shower with open wounds. I’m sure where she worked on me will be tender and sore. She was not gentle in trying to get the goo out. However, I can tell that the pressure that was under the skin is not as great as it once was.
I send out a friend request for transport to and from surgery. Holley, again, immediately volunteered to take me, wait for me and bring me home from surgery. No one is faster at answering a group text when I ask for help. I’ll have to buy her another adult coloring book. The ten hours she spent the last surgery probably gave her enough time to completely color her other adult coloring book.
You know how little things get you upset? I was a little miffed as I drove to the doctor this morning. My next door neighbor is having impact windows installed (I’m pleased for her since she’s alone and can’t lower her hurricane shutters). Today was yard trash and garbage pick up. The two guys installing the windows took all the cardboard surrounding the windows and put it in my yard waste bin.
I don’t care they used my bins but they needed to use the recycle bin, not yard waste. The city once issued me a warning when someone put their doggy poop bag in my yard waste bin. I called the city and complained and explained I couldn’t be held responsible for someone putting their dog waste in a bin that on the street to be picked up. I had no control over that. Deaf ears.
I fully expected a warning on my yard waste bin when I returned but apparently their either didn’t care or notice that it was full of yard waste and cardboard. It’s a silly thing to get upset over but with everything that been happening lately, it was one more thing I didn’t need to worry about.
Hallelujah! Dr. Burgers removed the drain! Tomorrow I can shower again. After 17 days, I still find myself habituated to the drain even though it is gone. I put things in a different pocket, check to see if I am snagging the tubing, thinking about checking the blood level in the bulb. It’ll take a while before I quit doing that.
The actual removal of the drain was simple. A couple of snips at the sutures and it pulled right out without pain. Then it was injections with lidocaine to numb me for aspiration.
She tried to aspirate the hematoma again to no effect. I’m scheduled another post-0p with her on Friday and if the hematoma and swelling over the former left breast hasn’t gone down, she’ll schedule me for a quick surgery on the following Monday or Tuesday to remove any other congealed blood in those areas. She said it would be about a 30 minute surgery with a small incision where she would suction the congealed blood out.
There is no danger of the hematoma in place. It would gradually resolve itself in a few months but she’s concerned about the pain associated with it – as am I. Of course, there’s no such thing as a 30 minute surgery because of the prep that is required and the post-op. In some ways, I wish she would go ahead and remove the hematoma surgically.
She put a bandaid over the opening for the drain and said it would probably drain some more but not to worry about it. She and the nurse also put a compression wrap around my chest in hopes of forcing the fluids into the lymph system and get it out of the area of swelling. It’s like having that bra on again.
Everyone at the cancer institute keeps asking me how I’m feeling. To be honest, depressed. The antibiotic keeps me on the toilet until the Lomotil kicks in. I’m sore and puffy near the surgery site and until today had to deal with that damned drain. I didn’t take the anti-anxiety medicine last night. Apparently, the trade name is Xanax (thanks Jimmie) and I guess I’ll start taking it again. I took it one night and not the next. Maybe I need to be on it for a while.
She also keeps commenting on the bruising. I finally told her it was because she was so mean to me during the original surgery. She didn’t laugh at that one. Then I told her that 74 year olds tend to bruise quite a bit for just about any reason.
It’s getting close to lunch time so I think I’ll partake of a couple of Duncan Donuts and a coke for lunch. When I was in junior high school, that was my breakfast. I would walk to the Gulf Cafe in Morton and sit at the counter and order a single donut and a coke. It was all I could afford for breakfast. Mom was either in her cups or missing in action so there was no breakfast at home. At the cafe, it got to be so regular that whoever was waiting tables would just go ahead and plop down my donut and coke without asking what I wanted. No, it wasn’t particularly nutritious but it got me to lunch time at the cafeteria at school. Back in those days, I think lunch was 25 cents and milk was two pints for a nickel. That way I got at least two meals a day.
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No plants to bore you with today. I just don’t feel like it. I’ll try again tomorrow. Stay tuned!
I was supposed to have two doctors’ appointments today but Dr. Burgers rescheduled for Monday. Instead, I met with Dr. Velez’ nurse, Danielle, and then later with Dr. Velez.
Danielle pretty much answered all my questions and by the time Dr. Velez came in, I had to come up with some new ones.
I cleared up the 9 weeks question I had. Even Danielle had it wrong. Dr. Velez follows the Dana-Farber protocol of using Herceptin and Taxol but he decided to modify the protocol, particularly for me since I’ve already had one chemotherapy that included Herceptin when I did the four drug regimen.
In essence, I’ll start chemo on August 21 at 9:30 am and will have it every Monday for 9 weeks. I will get 80 mg/l of Taxol for each of those Mondays. I also thought I would be getting Herceptin at the same rate but Dr. Velez will put me on the every-three-weeks regimen immediately for Herceptin so there will be only three times during the nine weeks that I get the Herceptin.
After the nine weeks, I’ll continue Herceptin alone, every three weeks for one year (or 14 sessions). Once my year of Herceptin is up, I’ll be on Tamoxifen for 10 years. The 10 years is based on research with people with the same genetic markers I have for my cancer.
Every infusion date, they will test my blood and pay particular attention to my white blood cell (WBC) count. If all normal, I will not need the next day injection to boost my immune system required with the old protocol. Apparently the two drugs they will give me during each infusion doesn’t destroy the bone marrow like the four drug regimen did.
Because Herceptin has effects on the heart, every two or three weeks I will undergo an echocardiogram – for a year.
Taxol, of course, has side effects. One is bone pain. They will preemptively work on that by administering Decodron before each treatment. It’s for arthritis (yes) allergenic reactions (yes) blood/hormone disorders (no) skin diseases (maybe) eye problems (no) breathing problems (no) bowel disorders (boy howdy!) cancer (yes) and immune diseases (no). Another issue with Taxol is peripheral neuropathy but unless it gets severe, and they don’t anticipate it to do so, they’ll stay the course on the dosage. Otherwise, they’ll cut back on the dose.
Taxol does cause diarrhea but Dr. Velez feels confident my low dosage for 9 weeks will allow me to skip that problem.
So, in summary, I’ll get 16 doses of Herceptin (one dose every three weeks) and 9 straight weeks of Taxol. That leads to a 97% survivability rate after 10 years.
I will still be able to eat fresh fruit and be around flowers. I must avoid crowds and sick people. Dr. Velez feels this Dana-Farber protocol is doable for me. I told him I was willing to try it but if it got to the point where I was with the four drug protocol, I would stop chemo.
I mentioned my episodes of depression and he has prescribed me Alprazolam 0.5mg tablets which should even out my mood swings. It’s actually an anti-anxiety medication that produces a calming effect. I told him antidepressants don’t work well on me and he says this will help. Of course, the pharmacy is having trouble with my insurance company on filling the prescription.
I also asked about skin tears and bruising. The four drug routine I was on previously had that as a side effect to the point they recommended you not use rectal thermometers because it might cause damage to the colon. Not to worry. I don’t use a rectal thermometer but it’s nice to know I don’t have to worry about excess bleeding and tears.
They want me to eat a protein rich diet. I really don’t have much of an appetite and haven’t been able to finish any meals lately. I did stop at the HoneyBaked ham store and got a BOLO sandwich, so two meals in one. I also purchased 2 lbs of HB Ham and froze one. I found out last week I can eat that.
I’ll also need to drink at least 2 quarts of water in a 24 hour period to flush the chemo out of my system. Neither of the two drugs seem to affect the kidneys as bad as the four drug regimen.
On the four drug regimen, I would not have been able to receive flu shots, Covid shots or when approved, RSV immunizations. I asked about that and he said it was perfectly fine to get the injections when they become available in the fall.
One handout said no ibuprofen and in the same handout, said it was OK. I checked and I can use Advil without any problem.
I asked once we are on infusions every 3 weeks, could I camp and hike. He said absolutely!
I feel this was as positive of a situation as I can possibly expect. I’ll give it a try. Now if I can get that damn drain removed!
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Bitter Melon, Balsam Pear (Momordica charntia)
This plant is considered to be a stage 2 invasive in Florida which means its on the increase but has not affected native plant communities – yet. It’s a tropical and subtropical vine and is planted in Asia, Africa and the Caribbean for its edible, albeit bitter fruit. Here, it’s a pest.
Every time I find it in my yard growing along the fence row I rip it out. When I do, the air around and my hands have this very pungent aroma from the vine. It’s not unpleasant but it certainly isn’t good smelling either.
Most people like it for the colorful orange fruit. The flowers are very much like flowers of the cucumber, cantelope and watermelon.
The flowers are monoecious meaning there are male flowers and female flowers.
I digress but there was a meme several years ago on Facebook about how to tell the ripeness of the watermelon and explained that male flowers produced a poor tasting melon and female flowers produced a good tasting melon. Tommyrot. Only the female flowers produce the fruit.
However, Momordica belongs in the same family as watermelons, cucumbers, and cantelope: the Cucurbitaceae.
The Biota of North America Program (BNAP) reports 25 genera in the United States.
Depression runs in my mother’s side of the family: aunts, uncles, cousins, mother, and me. In some members it’s more pronounced than in others. For example, my mother was committed and underwent shock treatments. What intrigues me is what small, inconsequential events trigger my depressions. It can be something as simple as breaking something around the house or when I was teaching a student saying something they didn’t realize was hurtful. Last night it was a text.
Strangely, the cancer diagnosis has not triggered any depression episodes or it could be that there has been an accumulation of things that a late night text triggered. I’ll do what I always do and withdraw and hunker down until things get better.
It’s been a gray morning (literally and figuratively) and added to that was my unexpected appointment with the surgeon, Dr. Burgers. Two nights ago was rough with burning pain, a rash, and soreness under the left axilla. Dr. Burgers worked me in this morning.
She kept saying “Your poor skin” where we think the tape that held the gauze in place over the drain insertion caused an allergic reaction. She recommended continuing the cortisone cream on the rash.
Next she addressed the soreness in the axilla which is apparently due to the hematoma. She numbed the region with lidocaine and attempted to aspirate the hematoma. Unfortunately, the blood in it had coagulated and she was having a hard time getting any blood out. She then injected some fluid into the hematoma to try to loosen up the clot and was a little more successful with the aspiration. There’s still about a half tennis ball size hematoma under the arm pit and it’s still sore but at least it’s smaller than it was. I was amazed she spent as much time as she did trying to loosen up the hematoma, particularly for a spur of the moment appointment.
She also removed the glue that covered the incision (relief!) and has prescribed an antibiotic from where she messed around the hematoma and drain insertion with needles. I’m to keep the Friday appointment with her and she mentioned she might remove the drain and let my body naturally acclimate.
I’m back to no showers (the semi-water proof tape may have been the cause of the rash) and I’m back to using bath wipes.
I’m not looking forward to the chemotherapy. I’m still unsure about how many times and with what drugs but I’ll find out more about that on Friday when I meet with Dr. Velez after my Dr. Burgers appointment. If it gets too much I may opt for my 10 year 75% chance as opposed to the 95%.
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Golden Arrow (Plumeria pudica)
Wikipedia reports this native to Panama, Columbia and Venezuela. What is interesting to me are the leaves. Botanically, the term is obovate which means they are wider at the tip than at the base. Wikipedia suggests they are like the hood of a cobra. Not sure I agree so I’ll stick with obovate. However, they certainly stand out.
The plant belongs in the dogbane family or Apocyanaceae. The family has undergone a significant revision since DNA analysis and there are a lot of species that have been added to the family since I was a graduate student.
As a member of this family, Plumeria is related to frangipani from which leis are made. It seems to be quite common in my neighborhood and it’s a pretty consistent bloomer.
Biota of North American Plants (BNAP) reports 24 genera in the U.S. I’ve photographed 7 genera and 13 species of the family in my travels. Click on links to see an image of the plant.
It was a miserable night. I couldn’t get comfortable with the drain insertion point. It felt like I had burned myself in that area. Not only that but I’m still very sore in the axillary region. There seems to be a lump there in the muscle tissue.
I finally couldn’t stand it any more so I removed the bandage from around the drain insertion.
Sorry for the gross photo.
I seem to have developed a rash around the drain area. In the photo above you can see the sutures that hold the drain in. I’m still bloodying tee shirts every day. I cleaned the area with rubbing alcohol and then put Neosporin on the rash and replaced the gauze and tape. I then covered it with Press and Seal to semi-waterproof it. It already feels much better.
I’m still donating 30 milliliters of blood every morning. It’s still dark red with no indication that it’s clearing. Looks like I’ll be forced to have the drain for a third week unless something drastically changes in the next few days.
I’ll call the Nurse Navigator later today and ask if they want me to come in and let them check out the rash. If not, I may go back to bed and sleep awhile since I was up at 4 am this morning with the burning.
Since I was up, I ate breakfast (bananas, strawberries, blueberries, and yogurt) and then was out the door for my morning walk at 6 am. It was still pitch black outside. This was the first time I got to photograph Riverland Road in the dark since the re-vamping of the road. It’s taken a couple of years but the wait was worth it.
Riverland now has two bike lanes (left and right side) and even better, reflectors have been spaced all along the road bed. The reflectors light up from either car headlights or from street lights and show you the edge of the bike lane.
You can see the reflectors demarcating the right side bike lane.
Even better, although not shown in the photograph, is the center line has yellow reflectors. Where you find a fire hydrant, the center line has a blue reflector so the fire department can easily determine the location of fire hydrants.
Even with street lights, Riverland used to be a very dark street at night. With new street lights, bike lane reflectors and center lane reflectors, there’s no reason for anyone to accidentally drive up on the swale. However, if you look at the front center of the above photograph, you can see where someone did manage to do that.
I don’t typically drive Riverland at night (nor anywhere else that much) but it certainly makes it a pleasant experience when I do. You tax dollars at work!
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Dioon (Dioon edule)
This plant belongs to my favorite group of plants, the cycads. They are considered extremely primitive and are related to the gymnosperms (think pine trees). They have fern-like characteristics (look at the fronds) but unlike ferns, produce seeds, not spores.
Cycads are dioecious which means there are male and female plants. Both produce cones. The male cones produce pollen and the female cones produce seeds when fertilized by the pollen from males.
Male and female cones of some cycads – from a poster by Patrica Fawcett
Dioon is a native of Mexico and Central America and is often planted as an ornamental in South Florida. A lot of people confuse them with palm trees, and indeed, one cycad commonly found down here is misnomered the Sago Palm (the species Cycas revoluta).
At one time, scientists considered the cycads to be wind pollinated, a very primitive form of pollination. Let’s face it, if the wind is blowing the wrong direction the day you start releasing pollen, your genes aren’t getting passed on that year.
It was Fairchild Tropical Garden in Miami that clued the world in on insect pollination of cycads. One of the grounds keepers noticed the native coontie (Zamia integrifolia) had beetles crawling all over the female cones. The Garden was later able to demonstrate that indeed, some cycads are pollinated by insects – considered a more advanced trait in plants.
Beetles that pollinate Zamia integrifolia (formerly Zamia pumila) – from a poster by Patrica Fawcett.
You find most cycads in South Africa and Australia although there are some in the Americas. Our only native species in the U.S. is coontie (Zamia integrifolia). Native Americans and then early settlers used the corms (short, vertical, underground stems) as a flour substitute.
The female cones of Zamia produce seeds with a fleshy covering that is carcinogenic so you have to be careful when handling the female cones. The red covering of the seeds can be quite striking.
The rarest plant in the world is a cycad of the species Encephalotoswoodii. There is only one known plant in the wild in South Africa and it’s a male. Good luck with passes on those genes! All others of the species are simply clones.
The cardboard palm pictured above is a little misleading. It can grow quite large – to the point of over 6 feet tall. I purchased one when I first moved to Florida and kept moving the potted plant with me where ever I moved. When I finally settled, I planted it in the ground. It took over the area in front of my front window. I finally had to remove it (no easy task) so I’m glad to have this one growing in my back yard.
I’m still recovering from the surgery. I seem to need to sleep a lot. Nap time has taken on a totally meaning in my life. I can get out and around (I did grocery shopping this morning) but feel kind of blah. No bad but not good. The hematoma from the surgery seems to be going down a little and I’m not nearly as bruised as before but I still drain about 30 ml of very dark red blood every 24 hours. I am still quite sore from the biopsy of the axillary lymph nodes but I have a good range of movement. I can now put on a tee shirt without grimacing.
I looked up how long you can keep a drain in and one cancer website said three weeks. After that, you are prone to infection. I seem to be heading to the three week time frame. I go back to the surgeon on Friday but I can’t believe my drainage will lighten in color much less turn straw colored or clear so I’m sure she’ll tell me it stays in. I still have to sleep on my right side because of the drain on the left.
A friend who had a hysterectomy also had a drain. I commented I was afraid I would scare little children with my bloody bulb pinned to the outside of my shorts and she said she wore hers on the inside of her underwear. A lightbulb went off and I realized my shorts have pockets!
I’m a creature of habit. My wallet goes into my left back pocket, my house keys and car fob go into my right front pocket, and my cell phone goes into my left front pocket. Ever the old fashioned guy, I have a handkerchief in my right rear pocket. Another confession. Until TSA got so snippy about pocket knives, I used to always have one in my right front pocket. I was always cutting off branches on field trips around campus to show students botanical concepts.
It never occurred to me to put the bulb in the pocket of my shorts. I did for the grocery shopping and the tube was neatly hidden by the shirt. Of course now I’m discombobulated because my phone has joined my house keys and car fob which causes me all kinds of confusion. Half the time I can’t find my phone now. If I still have the drain for Halloween, I think I’ll sit outside the house and pass out candy with the bloody bulb visible.
The feels like temperature is only 106°F today. We are yet to have our afternoon thunderstorm but there’s still time. I did manage 1.4 miles this morning but it was at 7 am and still somewhat cool, comparatively.
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On my walk this morning I passed a house that has their front yard looking like a jungle. Both the swale and the front yard are overgrown with both native and non-native plants and when you walk on the sidewalk it’s like you have a jungle canopy over your head. It’s a great look and I like all the plantings. One plant jumped out at me in that it was right at eye level.
Perfumed Passionflower (Passiflora viticola) – the specific epithet is because the leaves look like grape leaves.
Can you believe the color of this? I grew up with maypops or passionflowers (Passiflora incarnata). I always told my students it looks like a flower from outer space. Most of the genera Passiflora are said to be neotropical. Perfumed passionflower is native to Central America and northern South America. The fruit is technically a berry but I know the fruit of P. incarnata (maypop) is mostly hollow with fleshy seeds. I think most are all vines in their growth form.
It’s called a maypop because when you step on the egg-sized fruit, you get a loud pop as it splits open. My first exposure to this phenomenon was visiting my brother at his father’s house in Brandon and riding horses in his pasture. The pasture was full of maypops and the horses would step on them. Then when I walked the pasture, I would take great pleasure in jumping on the fruit to get the popping sound.
Later, I found out the fleshy covering (aril) over the seeds was edible and I became addicted. Unlike rattlesnake, the fleshy seeds didn’t taste like chicken. It had a creamy, tart taste that is very distinctive to the fruit. I always liked taking students around campus where we had P. incarnata growing and letting them taste the pulpy seeds. Food always interests young college students.
Most species are a source of food for butterflies and you can often see caterpillars feeding at will on the leaves.
Several years ago, my friend Chris gave me a young native species Passiflora suberosa. It’s also known as the corky stem passionflower which pretty much tells you what the stem looks like when cut open. It has a very tiny flower and is pretty much green or cream colored . It still grows along the northern edge of the pool in among my Cabada palms. Florida has 12 species of Passiflora and one hybrid species. As far as I know, the fruit of all species are edible.
Today was my first follow up with the surgeon, Dr. Burgers. Usually, when you go in, Lorraine, the nurse, makes you weigh, takes your blood pressure, oxygen level and temperature. This time she ushered me right back to a waiting room.
Prior to being called, there were two ladies in the waiting room madly filling out paper work. One had an accent and the other had a perfectly normal southern drawl. The lady with the southern drawl looked up at me and said I must have completed the paperwork earlier. I didn’t tell her this was my fourth visit. I just said I did it on line. Another lady came in and they got to talking and she told the southern drawl that she also had done everything on line. The lady with the accent was called back and she was still filling out the paper work as she left. They do ask a lot of questions and want to know you family’s medical history in detail. Both were having to consult their phones for information. I think both ladies will now start filling out online forms from now on.
Dr. Burgers began peeling off the old bandage and she was stunned at the amount of bruising. She kept saying “I don’t know why you are so bruised!” She also discovered there was a small hematoma in the area of the incision and where the drain exits my body. There was also a small blister where she thinks the tape rubbed against my chest.
She gave me the go-ahead for showering and I don’t have to keep a bandage over the incision. She put a plastic-like film over the bandage of the drain. The only bad news is that I have to keep the drain, at least until July 28. I have an appointment with the hematologist/oncologist at 3 pm that day and she managed to schedule me for a second post-surgery consult (and hopefully drain removal) at 1:15 that date.
I just noticed in the photo that I don’t have any axillary hair. I’m sure they shaved that for surgery but I’m also sure pulling the tape away took away any remaining hairs. Whatever tape they use these days is ultra sticky!
Speaking of hair, one of the side effects of chemo is the loss of hair. That’s not a problem for my head – it’s already gone. What surprised me was how little I have to shave now. I can tell my chest and legs are smoother than before but the freakiest is I now have hairless testicles! No need for me to manscape now. Not that I ever did.
I asked Dr. Burgers if she had received the final analysis of the lymph nodes and she said yes and that all was clear. The next steps are to finish healing, removal of the drain, and then begin chemotherapy. She expressed hope that it would be a little less traumatic than the first attempt. From her mouth….
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Today, a small tip of the hat to my major professor at Ole Miss, Dr. Pullen. I’ve mentioned he was originally from Florida, hence the emphasis on the coffee family of plants (Rubiaceae).
During my graduate school days, I found he did his doctoral dissertation on members of the Portulacaceae, the purslane family of plants. Wikipedia reports 115 species of a single genus, Portulaca. That is now. Back then, before DNA analysis of plants became a thing, there were 20 genera and 500 species of plants. It’s most common in semi-dry regions of the Southern Hemisphere but the genus is common in the southern U.S.
Today, 19 of those 20 genera are placed in the family Montiaceae and Portulaca stands alone.
I assume to earn a PhD in botany, he had to study and analyze the physical characteristics of those 500 species by either visiting herbaria all over the U.S. or having specimens sent to him on loan from all over the globe. You’d do things like measure every physical trait available on a herbarium specimen and at the same time collecting them in the field and doing the same analysis.
You can understand my excitement when I first moved to Florida and one of the first plants I ran into was Portulaca pilosa.
Pink Purslane (Portulaca pilosa)
It’s considered a succulent – meaning it has fleshy stems and leaves. The term pilosa comes from the hairs on the plant. It’s common in the southern U.S. and as far south as Brazil in South America. The drier the climate, the more hairy the plant becomes.
In South Florida, this plant can bloom year round and can be used as a ground cover. I have it in a strawberry pot and it seems to like spilling over the sides of the pot like strawberries.
Four species of Portulacca are found in Florida: P. pilosa, P. amilis, P. grandiflora, and P. polokiniensis.Biota of North America reports 17 species in the U.S.
Mea culpa. On the last post, I pictured a flower called Cushion Buckwheat (Eriogonun ovalifolium). It wasn’t. I’ve now corrected the image and if you look at the last post, you can see the plant. The reason I tell you this is that a former member of the Portulacaceae, Cistante umbellata was the one I mistakenly included in yesterday’s post. Both can have pink flowers.
Umbellate Pussytoes (Cistanteumbellata) Family Montiaceae
The other genus I’ve collected that was formerly in Portulacaceae is Calandrina ciliata.
Red Maids (Calandrina cilata) Family Montiaceae
If you look at the photo of pink purslane and the above photo of red maids, I think you can see why they would have been placed in the same family based on gross morphological characteristics.
Just to show you how fast things can change, when I did my three cross country trips to National Parks, the family Portulacaceae still had 20 genera. By the time I finished my last trip, the family had been totally revised to the single genus Portulacaceae. Either that or I hadn’t kept up with the literature. Just for the sake of it, I’ve included two other genera I photographed that were in the family at the time.
Genus/Species
Common Name
Location
Portulaca oleracea
Pink Purslane
Mi casa, Fort Lauderdale; Lake Louisa State Park, Florida; Big Bend National Park
